Herbie's rehabilitation diary

Background

TLS met Herbie, a New Forest pony, in May 2013. She had had laminitis on and off since the age of 5 - she was now 18. Her mother and half-sister also suffered from laminitis. She had clear signs of insulin resistance and PPID - a floppy crest, fat pads above the tail, behind the shoulder and filled supraorbital hollows, she was a little late to shed her winter coat, had some muscle and weight loss despite a huge appetite, urinated excessively and had suffered from rainscald. Unfortunately blood tests at a laboratory in France the previous year had tested only prolactin and cortisol, both worthless for diagnosing PPID.

Her farrier expressed doubt that her feet could be improved, saying they were "trimmed enough", and generally trimmed her feet only every 6-8 weeks.

Mid July a remedial farrier gave a second opinion on her feet and said he wouldn't change anything about the trim, despite Herbie being in obvious discomfort, unwilling to pick up her feet, moving reluctantly, standing and moving in a laminitic stance, and paddling her front feet. Remedial trimming was started under TLS guidance. At the end of July Herbie started on 0.5 mg Prascend - no pergolide veil effects were seen.

01 August we were surprised, but very pleased, to find Herbie's soles had changed from being completely flat to being concave, her collateral groove depths at the apex of the frog had changed from around 2 mm to 1 cm. She had been quite laminitic in her pose and movement, and pointing her LF toe downwards, so her owners had her back on 2 Bute/day, which had improved her mobility (not necessarily a good thing). We had planned to try padding her feet, but given these positive changes we decided against it, partly because fitting pads would have been one more thing for Herbie's owner to cope with, and Herbie was still confined on a bed of deep conforming sawdust. In hindsight this was probably a mistake.

07 Aug Herbie's owners reported that she still wasn't comfortable.

TLS recommended body work for Herbie - we weren't sure whether her discomfort was due to ongoing laminitis, foot pain or general body discomfort from so many years of laminitis and uncorrected feet.

09 Aug TTouch practitioner Danielle Dibbens visited Herbie for the first time. She said afterwards she was shocked by how cold Herbie's limbs were. Danielle left Herbie's owners with TTouches to do every day, including Python Lifts. Herbie's owner reported that doing these TTouches warmed Herbie's cold legs amazingly.

18 Aug Herbie's owner reported that she was still very up and down - some days she'd walk freely, others she was doddery or hardly moved. She was very reluctant to pick up her feet, and her legs and feet were still cold. Her hoof growth seemed very slow. However since all her hay had started to be soaked, and perhaps linked to starting on Prascend, her neck seemed less cresty. She was vaccinated for tetanus with no ill effects on 19 Aug and had blood tested for insulin.

Due to her lack of continual progress, and her owner's challenging personal and financial circumstances, TLS offered to take Herbie for a couple of months of full-time rehabilitation.

22 Aug Danielle visited Herbie for the second time, along with TLS and a visiting Dutch vet student, who immediately picked up how cold Herbie's limbs were, although her front limbs and feet were warmer than they had been previously. We could see improvements in Herbie, although she appeared to have lost more weight. After her bodywork session Herbie had some time for reflection, and when we went back to her she was moving around her shelter quite freely, was more obliging about picking her front feet up, as long as we had her standing in a good position before we asked, and her front feet felt much warmer than they had. Picking up her hind feet was still a struggle.

24 Aug TLS visited Herbie and fitted Easyboot Trail boots with thick EVA pads on her front feet. The boots and pads made her instantly more comfortable - in hindsight we should have done this sooner. Herbie was looking much better, bright and interested and walking around quite freely inside her stable, although with a stilted "walking on the heels, legs out in front" movement, and she was fairly happy to pick up her front feet, better with her left fore (which had the more obvious bone loss). Her owner reported that she was being quite irritable and had tried to kick her. Possible reasons we considered for this: gastric ulcers due to long-term restricted food; pain from ongoing laminitis as she was still paddling slightly; possibly pain from returning circulation - her front legs and feet were warmer than previously; Prascend starting to work and reducing hormones (e.g. beta-endorphin) that may have been keeping Herbie calm and lethargic, and also possibly giving anti-inflammatory and pain relieving effects; simply feeling well enough to complain about things! In case of ulcers, TLS lent Herbie's owner a couple of small-holed haynets, and suggested hanging one from a central beam so that the net would swing and slow down her hay consumption further.

25 Aug Herbie's owner reported that Herbie was on fine form, marching around her stable waiting for her hay and being very vocal! She clearly loved the boots and her owner had trouble persuading Herbie to let her take them off - we wanted to build up their use gradually to prevent rubbing. The small holed haynets were already in use, and Herbie had hay in front of her for longer than normal because of this, making for a much happier horse.

Week 1 - 31 Aug-06 Sept - Herbie arrives at TLS

Herbie arrived at The Laminitis Site on the last day of August. She was given Bute the day before, of and after travelling, and travelled with her Easyboot Trails and thick pads on her front feet (she hadn't wanted to pick up her hind feet to have boots put on them too). She was a bit uncomfortable after travelling, paddling and with slightly raised digital pulses, and cold limbs, but rapidly improved and was soon moving freely around her shelter wearing boots and pads on her fronts. She quickly settled and seemed very relaxed. She was eating well, but rather frantically, trying to eat all her soaked hay as soon as it was given to her, so to slow her down and spread her food out through the day we gave her small nets of hay every few hours, using small-holed and even double-small holed haynets, and hanging several around her shelter. Within a couple of days she realised that she was always going to have hay in front of her, and she stopped trying to bolt it. By this time she was no longer showing signs of laminitis, so we were able to start feeding her part of her hay ration from a large tub on the ground.

She spent the first couple of days in her 4 x 7 m shelter on a deep shavings bed, until 48 hours after her last Bute, then she was allowed out onto an eaten off area of ground about the same size as her shelter - this was the first time for months that she had had the sun on her back. She had company from other horses, behind a double fence so that they couldn't touch.

The ground was hard and dry, so whenever she wasn't enclosed on her deep shavings bed she had Easyboot Trail boots with thick EVA foam pads on all 4 feet. Overnight she was enclosed in her shelter with her boots off, so that her feet could dry out. Her legs and feet were still cold, so she wore leg wraps or polo bandages overnight and on cooler days, and she was kept rugged unless the weather was warm.

Danielle came four days after Herbie's arrival to give her a third TTouch session. Herbie remained in the shelter for this, the session consisted mostly of touches to help improve the circulation to her legs and feet, and these TTouches were repeated every day. Her legs and feet soon began to feel closer to a normal temperature.

At this point Herbie found it very difficult to pick her feet up at all, Danielle didn't try to pick her feet up during this session. However, if we were to improve her feet, we had to be able to pick them up, so we started to retrain Herbie to pick her feet up, by gently tapping her on the back of the leg below the knee, and rewarding the slightest "try" with a tiny food treat (she was very motivated by food). Before long we could pick all 4 feet up, but only just off the ground and only for moments at a time.

Week 2 - 07-13 Sep - formal exercise begins

Herbie's enclosure was quite quickly expanded until she had a 25 m long strip, and she was encouraged to walk around by placing her hay, water and feed buckets at both ends of the strip. We started to encourage her to follow us around the strip for small food rewards, and once she was happy doing that, we started formal in-hand exercise sessions, just a few minutes walking at first, and building up to around 15 minutes twice a day.

These sessions were not without problems. Herbie was very on her forehand, wanting to walk quickly, and quite disconnected and uncoordinated behind - her quarters didn't necessarily follow her shoulders. She could be rather bad mannered, rushing through gateways, walking through her handler, bucking and trying to rush off, and rolling during her exercise sessions. She was calmly told that this behaviour wasn't acceptable no matter who was handling her. We decided that she had "quite a lot of character" - which wasn't a bad thing at all, but it needed channelling!

She made good progress, moving and turning really well and now walking 20 - 30 minutes/day in-hand and doing lots of S shapes. She spent daytime in her 25 m strip, and was enclosed in the shelter overnight with her boots off so that her feet could dry out. However she was quite hard work to walk as she seemed to find it very boring, she'd rolled a couple of times when being walked, and was walking with her head down seemingly thinking about rolling as soon as she realised we were in the field to walk rather than to eat. She was happy to walk to another field (where there might be grass), happy to walk loose in pursuit of moving food, and happy to trot out of her strip to come into the big field for grass, so we were pretty confident that discomfort wasn't an issue. A couple of times she exploded on the lead rein, bucking and rearing and being quite unpleasant and rude, and making walking with a loose rein impossible.

Herbie was picking up all her feet pretty well now, she still struggled with her hinds, but we suspected that might be more mental than physical as when we insisted she was able to hold them up quite well, and she was finally comfortable enough to have them trimmed. We started to do some leg circles.

Herbie was having 3 feeds a day based on rinsed/soaked/rinsed sugar beet, and constant hay, but wasn't really putting on any weight. We felt her water consumption was a little high, considering that all her hay was soaked, but her bedding was remarkably dry. Her care was quite time consuming, with regular deliveries of hay, feed and water, keeping her shelter and strip clean, changing boots, leg wraps and rugs, grooming, checking and picking out her feet, TTouches, exercise twice a day and moving her into the larger field to graze once or twice a day.

She started to be allowed a short time grazing in the field immediately after her exercise sessions.

Her foot picking-up training continued every day, and before long she was happy to pick up all 4 feet to a voice command or gentle tap on the back of her leg. We started to do brief leg circles, and she was able to have her feet assessed and to have very short trimming sessions.

Week 3 - 14-20 Sept - TTouch groundwork

Herbie was now much better to handle. When her owner visited this week she walked her for 30 minutes and we set up a wide labrynth which Herbie had no problem going round and over. We were now doing leg circles with all 4 legs, still doing TTouches on her legs, and asking Herbie to pick up her feet in response to a tap, rather than us lifting her foot, and asking her to allow us to put each foot down when we were ready. This was going well, although we rarely got a perfect response the first time of asking with her hind legs. She was still getting small treats for her foot work, but now having to do more to earn the same treat. According to her owner she had always been bored with school work, but liked poles and circus trick stuff. so we hoped that the labyrinth and pole work might keep her a bit more interested, and that with a regular pattern of walking then grazing she would soon work out that it was worth behaving. After her exercise she was having around 30 minutes of grazing in the larger field, but was happy to come back to her strip for breakfast/tea and started to trot in for her bucket - she looked sound and much freer. So far so good, we were delighted with her progress.

Danielle came to see Herbie for the fourth time and noted that all her legs felt warm. She was able to do groundwork with Herbie for the first time - stops and starts, some work in the labyrinth, half walk then stop, and we had a go at Homing Pigeon with a handler on each side. Danielle recommended encouraging Herbie to breathe by taking big breaths and sighing ourselves. Danielle was able to do lots of bodywork with Herbie after her groundwork session, Herbie was loose and chose to stay with Danielle.

Week 4 - 21-27 Sept - heel rubs, teeth and attitude

She was now happy to have all her feet picked up and trimmed, and stood without being tied up for this to happen. Her toes were shortened on the front feet, and she seemed to walk more confidently after this. Her soles appeared to tell a different story to the outside of her feet - looking at the soles her toes looked if anything too short, but the sole had presumably migrated forward and her white line had been lost, and her heels seemed to be back as far as the widest part of the frog, but from the outside (lateral view) the toes looked as if they needed to come back and the heels needed to come down. Her feet were extremely hard and it was next to impossible to find live sole, the sole at the back of the hoof was very compacted. We had considered soaking her feet to try to loosen everything up, but decided not to because of her heel bulb rubs. Rain was forecast, so we decided to wait and hope that puddles might form in which we could soak her feet, or perhaps the ground become soft enough for her to spend some time without boots. She was now working without boots on her hind feet, at first just on grass, but then also in the school, and she seemed perfectly happy - she had reasonable sole depth and concavity on her hinds.

Started to work Herbie in the sand school to encourage her to keep her head up and not look for grass. We kept sessions "busy" with lots of loops, halts, half walks, rein backs, changes of direction, walking over poles and through the labyrinth, and if she started to get bored we took her for short walks in a field and walked up and down the banks surrounding the school. We used a simple figure of 8 body wrap on her, which seemed to help her coordinate her back end better. We used a schooling whip in front of her to indicate direction, and brought in towards her chest to indicate halting, and always plenty of voice commands. We were still having the odd obedience issue with her saying no, rolling if we weren't quick enough to stop her, trying to tear out of gateways if she thought she might get to grass, and throwing quite explosive tantrums, but we implemented a strict regime, didn't work her in the field she grazed in, didn't turn her out in the larger field unless she had worked first, and insisted on her not passing her handler, stopping and waiting for a command to walk on, particularly at gates, and asked her to stop and breath calmly if she started to get excited, and by the end of the week these incidents had stopped. She had had a blatant disregard for people's space too, so as she became more agile we started working on ensuring she moved out of our way, and not the other way round, stepped back if we entered her stable, and kept back and waited for her feed buckets and hay.

Unfortunately Herbie developed slight rubs on her front heel bulbs, most likely from sand getting into the boots while she was working in the school, as this was new, although she was wearing her boots for well over 12 hours a day. Vetwrap wrapped from hoof to fetlock helped to lessen the rubbing, but we found that EVA foam pads taped on to her feet worked very well and gave her the sole protection she needed for a couple of days while her heel bulbs healed - see EVA foam pads - the ground was too hard and dry and her sole still too thin in front of her frogs for us to risk letting her walk around without sole protection.

Herbie had her teeth checked by EDT Peter Smith. We had noticed that she was dropping a lot of her bucket feed. Peter found that she had a wave mouth and some significant sharp edges which he was able to improve greatly. Herbie was perfectly behaved to have her teeth done.

Week 5 - 28 Sep-04 OctDanielle came to give Herbie another TTouch session. Anne brought her friend Sue to watch. Sue hadn't seen Herbie since she came to TLS, and expressed amazement at the progress she had made.The ground was softer after recent rain, so Herbie started to spend time without boots or pads when she was turned out in her strip. This helped to soften her feet and encourage her frogs to shed. Walking towards me without boots, she definitely appeared to be walking heel first - hurray!

Week 6 - 05-11 Oct

Herbie had her front feet x-rayed for the second time. We knew from looking at the outside of her feet that there was still toe to come off, and that the heels needed to be lower, but this was less clear when looking at the sole, so we didn't want to go much further with her trim without x-rays.

The position of the drawing pin was marked on the foot before removing the pin.

We knew from the lateral view that there was still toe and heel to come off...

Week 7 - 12-18 Oct

Week 8 - 19-25 Oct - long reining and worming

Herbie continued her in-hand work and was introduced to long-reining - a good form of exercise for a recovering laminitic as there's no weight on the back and tight turns can be avoided. Her grazing time in the larger field was built up to 30 to 60 minutes twice a day, depending on the weather and how much exercise she had had. On days we were short of time to exercise her, we turned her out in her muzzle and she exercised herself! She was wormed with ivermectin - we wanted to use single dose wormers at least a week apart to hopefully reduce any possible negative effects, so next week she will be wormed with praziquantel for tapeworms.

With her muzzle on, Herbie exercised herself!

Herbie was wormed with no ill effects.

Week 9 - 26 Oct-02 Nov - trot and going home

Herbie continued her long-reining and in-hand work. As she was happy to trot and canter when loose in her strip, we started to ask for just a few steps of trot in a straight line in the school.

01 Nov - Herbie decided she wanted to trot or canter everywhere she went - she was ready to go home!

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